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General NPI Number Information
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NPI Number | 1114743630
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Entity Type | Individual
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Provider Name | KENNETH CRESSWELL
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Gender | Male
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Dates
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Enumeration Date | 11/30/2024
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Last Update Date | 04/29/2025
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Provider Practice Location Address
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Address Line | 11720 BELTSVILLE DR STE 500
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City | BELTSVILLE
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State | MD
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Zip | 20705-3139
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Country | US
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Telephone | 410-982-7179
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Fax |
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Provider Business Mailing Address
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Address Line | 11720 BELTSVILLE DR STE 500
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City | BELTSVILLE
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State | MD
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Zip | 20705-3139
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Country | US
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Telephone | 410-982-7179
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | R239144
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License Number State | MD
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